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A pulmonary embolectomy is a surgical procedure used to remove emboli in the pulmonary arteries. An embolus is a mass that detaches from the body, potentially clogging an artery if it travels through the bloodstream.
A pulmonary embolectomy is usually performed in an emergency setting to avoid necrosis, a serious complication that may occur if blood flow is significantly or permanently obstructed by an embolus. As a high-risk procedure, it is performed only when other treatment alternatives, such as thrombolysis and anticoagulation, have failed.
Some experts criticise the procedure claiming that it is unnecessary in many cases. For this reason, it was almost abolished, which resulted in some cardiothoracic surgeons not receiving training for the procedure. Now, however, a pulmonary embolectomy is still considered as an important tool primarily for the treatment of advanced pulmonary embolisms but is only usually performed in combination with anticoagulation therapy.
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A pulmonary embolectomy can be recommended to patients who suffer from advanced cases of pulmonary embolism (massive or submassive). This is a serious and life-threatening medical condition caused by a blockage in one of the blood vessels in the lungs. In most cases, the condition causes various symptoms including chest pain and breathlessness.
In non-severe cases, embolisms are treated with anticoagulation therapy using heparin followed by warfarin.
However, some patients do not suffer from any symptoms, making the condition hard to detect, until it escalates into a massive case characterised by the following symptoms:
- Profound dyspnea at rest
- Sudden collapse
- Arterial hypotension
- Cardiogenic shock
Massive embolisms are life-threatening. Most cases of the condition are linked with deep vein thrombosis (DVT), which is a blood clot that develops in the leg. When the clot detaches from its position and travels through the bloodstream, it can get lodged in the pulmonary arteries and cause an obstruction.
Other causes of pulmonary embolism include:
- Fatty materials from the marrow of a broken bone
- Drug misuse, or the presence of a foreign material from an impure injection
- A small detached piece of a tumour
Meanwhile, the following are considered as risk factors for DVT and PE:
- Recent surgery
- Recent trauma
- Congestive heart failure
- Chronic lung disease
- Prior DVT
In patients without a history of the above risk factors, diagnosis is more challenging, as some of the early symptoms of a massive PE are similar to those caused by hyperventilation syndrome. This may lead to a misdiagnosis, causing doctors to mistakenly discharge patients. A thorough physical examination is therefore helpful, as massive PE also cause physical signs such as:
- Distended veins in the neck
- Tricuspid regurgitation murmur
- Accentuated P2
- Parasternal heave
- Sinus tachycardia, often detected in an ECG
Other possible but very rare causes include:
- Large air bubble that forms in a vein
- Amniotic fluid due to pregnancy or childbirth
The results of a pulmonary embolectomy may vary depending on the size and location of the embolus, but is also heavily influenced by how early the PE was diagnosed, the surgical technique used, and post-operative care.
Recent studies show that the mortality rate following the said procedure is now at around 20%. Although still relatively high, it is considered to have drastically improved from its previous rate of 30%. Thus, the procedure is still being performed due to its life-saving potential.
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There are now a number of different techniques used to perform pulmonary embolectomy. These include:
- Surgical embolectomy – This is a major open surgery wherein the clot is removed by making an incision in an artery and blood vessel
- Balloon embolectomy – This is performed by inserting a catheter with an inflatable balloon into an artery. Once the catheter passes the clot, the balloon is inflated, and the clot is removed as the catheter is withdrawn. The catheter used in this procedure is called a Fogarty as it was invented by Thomas J. Fogarty. So far, the procedure has a recovery rate of 87.5%.
- Aspiration embolectomy – This is performed by suctioning the thrombus or embolus out. The procedure has a survival rate of 72%, but the chance of successful treatment is higher if the patient undergoes the procedure within 48 hours from the first onset of symptoms.
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A pulmonary embolectomy is a high-risk procedure linked with a number of potential complications. A balloon embolectomy, although minimally invasive, places patients at risk of:
- Intimal lesions, which can cause another thrombolus to form
- Ruptured blood vessel
- Cholesterol embolism
- Pericardial tamponade
- Pulmonary hemorrhage
- Blood loss
- Anaphylactic reaction
Death during or after an embolectomy is associated with delays in diagnosis and surgery.
Despite being considered as a high-risk procedure, its outcomes have significantly improved over the last 20 years, and overall mortality rating has reduced from 30% to 19%.
Sabri SS, Saad W, Turba A, Park A, Angle J, Matsumoto A. “Percutaneous pulmonary embolectomy: Indications, techniques, and outcomes.” Vascular Disease Management. 2010; 7:E223-E229. http://www.vasculardiseasemanagement.com/content/percutaneous-pulmonary-embolectomy-indications-techniques-and-outcomes
Aymard T, Kadner A, Widmer A, Basciani R, Tevaearai H, Weber A, Schmidli J, Carrel T. “Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy – should surgical indications be revisited?” European Journal of Cardio-Thoracic Surgery.” http://ejcts.oxfordjournals.org/content/early/2012/03/29/ejcts.ezs123.full
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Meta Title: Pulmonary Embolectomy: A Life-Saving Procedure for Pulmonary Embolism
Meta Description: Learn about pulmonary embolectomy, a surgical procedure to remove blood clots in the lungs. Understand the benefits of this procedure and what you can expect in terms of results.
Pulmonary embolism is a serious medical condition that occurs when a blood clot gets lodged in one of the pulmonary arteries in the lungs. If left untreated, it can lead to severe complications, including death. Pulmonary embolectomy is a surgical procedure specifically designed to remove these blood clots and restore blood flow to the lungs. In this article, we will provide an overview of pulmonary embolectomy, discuss its benefits, and outline what you can expect in terms of results.
Overview of Pulmonary Embolectomy:
Pulmonary embolectomy, also known as pulmonary thrombectomy, is an invasive procedure performed by a cardiothoracic surgeon to remove blood clots from the pulmonary arteries. It is typically considered for patients with severe cases of pulmonary embolism who are in critical condition or have failed to respond to less invasive treatment options, such as anticoagulant medications.
The procedure involves making an incision in the chest to access the pulmonary arteries, where the blood clots are located. The surgeon then removes the clots using specialized instruments, such as suction devices or forceps. Once the clots are removed, the blood flow to the lungs is restored, reducing the risk of further complications.
Benefits of Pulmonary Embolectomy:
1. Life-saving procedure: Pulmonary embolism can be a life-threatening condition, and pulmonary embolectomy offers a chance of survival for patients in critical condition. By promptly removing the blood clots, the procedure can prevent further damage to the lungs and heart.
2. Rapid restoration of blood flow: Unlike anticoagulant medications, which may take time to dissolve blood clots, pulmonary embolectomy provides an immediate solution by physically removing the blockage. This rapid restoration of blood flow can help alleviate symptoms such as shortness of breath and chest pain.
3. Reduced risk of recurrence: By directly removing the blood clots from the pulmonary arteries, pulmonary embolectomy reduces the risk of recurring embolic events in the future. This is particularly beneficial for patients who have a high risk of developing subsequent blood clots.
Expected Results of Pulmonary Embolectomy:
The success of pulmonary embolectomy depends on various factors, including the patient’s overall health, the extent of the blood clots, and the promptness of the procedure. Although every case is unique, here are some expected results following pulmonary embolectomy:
1. Improved lung function: By removing the blood clots, pulmonary embolectomy can improve lung function and oxygenation. This can help alleviate symptoms such as shortness of breath and increase the patient’s overall quality of life.
2. Reduced risk of complications: Pulmonary embolism can lead to complications such as right-sided heart failure, pulmonary hypertension, or death. By removing the blood clots, pulmonary embolectomy reduces the risk of these complications and improves patient outcomes.
3. Faster recovery: While the recovery period may vary for each patient, pulmonary embolectomy generally allows for a faster recovery compared to other treatment options. This can mean a shorter hospital stay and a quicker return to normal activities.
4. Improved long-term prognosis: Studies have shown that pulmonary embolectomy can significantly improve long-term survival rates for patients with massive or submassive pulmonary embolism. By addressing the root cause of the problem, the procedure offers a better long-term prognosis for these patients.
In conclusion, pulmonary embolectomy is a life-saving procedure for patients with severe pulmonary embolism. By removing blood clots from the pulmonary arteries, it restores blood flow to the lungs and reduces the risk of complications. The benefits of pulmonary embolectomy include its life-saving nature, rapid restoration of blood flow, and reduced risk of recurrence. Patients undergoing pulmonary embolectomy can expect improved lung function, reduced risk of complications, faster recovery, and an improved long-term prognosis. If you or a loved one has been diagnosed with severe pulmonary embolism, consult with a healthcare professional to determine the most appropriate treatment option, which may include pulmonary embolectomy.
| Benefit of | Expected |
| Pulmonary Embolectomy | Result |
| Life-Saving | Improved |
| Procedure | Lung |
| | Function |
| Rapid Restoration of | Reduced Risk |
| Blood Flow | of Complications|
| Reduced Risk of Recurrence | Faster |
| | Recovery |
| Improved Long-Term | Better |
| Prognosis | Survival Rate |